HomeMy WebLinkAboutPage 1 Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:22 ""?a —)V Permit Number:
5 J
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fart Pierce FL 34982 %
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 54/1
Legal Description: nn nn
Property Tax ID#: oc- v2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
tiona wor to e e orme under is perms —check a app y:
❑HVAC ��G Tank Gas Piping _Shutters ❑Windows/Doors
11 Electric LJPlumbingSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ UtilitiestSewer OSeptic Building Height:
OWNER ESSEE: CONTRACT R:
Name k y0y.. Name: Q
Address:/ 337A Com ny:
City: lei 4 p20 T A e
Zip Code: Fax: 0 State: Z
Phone No. Zi Code: Fax:
E-Mail: Phone N . 0
Fill in fee simple Title Holder on next page(if different E-Mail: & Crmi*/ h 1� h)a:YIz
from the Owner listed above) State or County License: �'Fly/4A 7 402�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.